DHSS MO
MISSOURI DEPARTMENT OF ELEMENTARY AND SECONDARY EDUCATION

OFFICE OF CHILDHOOD

FAMILY HOME INSPECTION REPORT
Facility Information

JACKSON, MILDRED

000645350

(573) 719-3410

2122 SPRUCE
HANNIBAL
MO  63401

JACKSON, MILDRED



 


MISSMILLIE@DOUGLASSONLINE.ORG


BETHANY C DUCKWORTH

BIRTH - 13 YEARS

10

FAMILY HOME

IF ONLY 4 CHILDREN PRESENT, ALL CHILDREN MAY BE UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 2 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER; UP TO 10 CHILDREN IN CARE NO MORE THAN 4 CHILDREN UNDER AGE 2 WITH 2 ADULT CAREGIVERS; UP TO 6 CHILDREN IN CARE NO MORE THAN 3 CHILDREN UNDER AGE 2 WITH 1 ADULT CAREGIVER
 
Inspection Information

08/20/2019

10:05 AM

11:07 AM

UNANNOUNCED

COMPLIANCE MONITORING

2362203032


DocumentDocument-Date
ASSISTANT APPROVAL REQUEST 06/15/2016
REGISTERING FICTITIOUS NAMES 06/15/2016
SANITATION INSPECTION 06/27/2019
APPLICATION 08/13/2018
EQUIPMENT LIST 08/13/2018
FIRE/SAFETY INSPECTION 09/19/2018




Inspection determined facility to be in compliance with licensing rules.
Open Violations: 4
NOTE
The licensee is responsible for compliance with all licensing rules, including but not limited to the rules listed on this compliance report form.
Attendance at Time of Inspection
Total Staff 1
Total Children 4
StaffChildClass AgeNote
1 4 MIXED Staff: Millie Jackson One 2 year old, Three 3 year old. 0 related children. Age range 2 years to 3 years.

 
19 CSR 30-61.025 Organization and Administration
Compliance
19 CSR 30-61.045 Initial Licensing Information
Compliance
19 CSR 30-61.055 License Renewal
Compliance
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home
Violation
 Provider Comments
Violation
The facility has not met the requirements for fire and safety as evidenced by the fire/safety inspection conducted 7-23-2019 was not approved.
Licensing Rule Reference
19 CSR 30-61.085 Physical Requirements of the Family Day Care Home 1 (B) states: The premises shall conform to the fire and safety requirements of the State Fire Marshal or his/her designee.
Correction Required
The facility shall comply with fire and safety requirements.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.086 Fire Safety
Compliance
19 CSR 30-61.090 Disaster and Emergency Preparedness
Compliance
19 CSR 30-61.095 Furniture, Equipment and Materials
Compliance
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel
Violation
 Provider Comments
Violation
Requirements for safe sleep training were not met as evidence by the provider did not complete safe sleep training in that Safe Sleep training had expired and provider does not have documentation of current Safe Sleep training.
Licensing Rule Reference
19 CSR 30-61.105 The Day Care Provider and Other Day Care Personnel 5 . states: Every three (3) years the provider and assistant(s) in a family child care home licensed to provide care for infants less than one (1) year of age shall successfully complete department-approved training regarding the American Academy of Pediatrics (AAP) safe sleep recommendations contained in the American Academy of Pediatrics Task Force on Sudden Infant Death Syndrome. Technical report – SIDS and other sleep-related infant deaths: expansion of recommendations for a safe infant sleeping environment, by Moon RY, which is incorporated by reference in this rule and published in PEDIATRICS Volume 128, No. 5, November 1, 2011, and available from the University of Vermont College of Medicine, Given Building S261, 89 Beaumont Avenue, Burlington, Vermont 05405-0068, telephone number 802-656-2505, fax number 802-656-4844, or at www.pediatrics.aapublications.org/content/128/5/1030.full. This rule does not incorporate any subsequent amendments or additions.
Correction Required
Provider and assistant shall complete department approved safe sleep training as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.115 Day Care Family and Household
Compliance
19 CSR 30-61.125 Medical Examination Reports
Violation
 Provider Comments
Violation
Child's medical examination report did not contain evidence that child’s current health is satisfactory for participation in a day care program.
Licensing Rule Reference
19 CSR 30-61.125 Medical Examination Reports 2 (B) states: Examination reports shall determine if a child's medical history and current state of health is satisfactory for participation in a day care program.
Correction Required
Child medical requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

19 CSR 30-61.135 Admission Policies and Procedures
Compliance
19 CSR 30-61.145 Nighttime Care
Compliance
19 CSR 30-61.155 Overlap Care of Children
Compliance
19 CSR 30-61.165 Emergency School Closings
Compliance
19 CSR 30-61.175 Child Care Program
Compliance
19 CSR 30-61.185 Health Care
Violation
 Provider Comments
Violation
Requirements for immunization reports on file were not met as evidenced by Child A immunization record(s) was/were not on file .
Licensing Rule Reference
19 CSR 30-61.185 Health Care 4 (A) states: No child shall be permitted to enroll in or attend any day care facility caring for ten (10) or more children unless the child has been adequately immunized against vaccine preventable childhood illnesses specified by the department in accordance with recommendations of Immunization Practices Advisory Committee (ACIP). The parent or guardian of the child shall provide satisfactory evidence of the required immunizations. Satisfactory evidence means a statement, certificate or record from a physician or other recognized health facility or personnel, stating that the required immunizations have been given to the child and verifying the type of vaccine and the month, day and year of administration.
Correction Required
Child immunization requirements shall be completed and on file as required.

Correction Verification
Submit Documentation

Compliance Date

Violation
Facility did not submit the Immunization Status annual summary report showing immunization status of each child enrolled by January 15.
Licensing Rule Reference
19 CSR 30-61.185 Health Care 4 (D) states: The administrator of each day care facility shall prepare a record of immunization of each child enrolled in or attending the facility. An annual summary report shall be made by January 15 showing the immunization status of each child enrolled, using forms provided by the department. The immunization records shall be available for review by department personnel upon request.
Correction Required
Facility shall submit an annual summary report by January 15 showing the immunization status of each child enrolled.

Correction Verification
Submit Documentation

Compliance Date
2/26/2019
19 CSR 30-61.190 Nutrition and Food Service
Compliance
19 CSR 30-61.200 Transportation and Field Trips
Compliance
19 CSR 30-61.210 Records and Reports
Compliance
19 CSR 30-63.040 Background Screening Findings
Compliance
RSMo 210.003 Immunizations of children required, when, exceptions--duties of administrator, report--notification of parents, when.
Compliance
RSMo 210.1080 Background checks required--definitions--procedures—ineligible for employment, when--exemption, when--emergency rules.
Violation
 Provider Comments
Violation
The provider did not meet requirements for requesting a criminal background check. The provider did not request the results of a criminal background check for Millie Jackson prior to January 31, 2019.
Licensing Rule Reference
RSMo 210.1080 Background checks required--definitions--procedures—ineligible for employment, when--exemption, when--emergency rules. 2. (3) states: A family child care home, group child care home, child care center, or license-exempt child care facility that has child care staff members at the time this section becomes effective* shall request the results of a criminal background check for all child care staff members by January 31, 2019, unless the requirements of subsection 5 of this section are met by the child care provider and proof is submitted to the department of health and senior services by January 31, 2019.
Correction Required
Required requests of criminal background checks shall be on file.

Correction Verification
Submit Documentation

Compliance Date
8/20/2019
RSMo 210.252 Fire, safety, health and sanitation inspections, procedures - variances to rules granted when - rules authorized.
Compliance